PROJECT SUMMARY Background. The risk of stillbirth, preterm delivery, low birthweight and other adverse pregnancy outcomes is extremely high in Sub-Saharan African countries including Botswana, especially among HIV-positive women. Daily iron and folic acid supplementation during pregnancy could reduce adverse pregnancy outcomes by reducing maternal anemia. However, the effectiveness of supplementation in subgroups defined by HIV status, anemia, gestational age, and other clinical, demographic and geographic factors remains unknown and compliance with supplementation guidelines is variable (<50% in Botswana). Cost-effective interventions to provide supplementation to pregnant women in Botswana and other resource-limited settings should be designed to address key barriers to successful supplementation and to reach subgroups that would benefit most from intervention. This K01 provides a unique opportunity to address this gap in the literature. Candidate Overview. My long-term career objective is to become an independent investigator who specializes in interventions to improve maternal and child health in resource-limited settings. My background is in applications of epidemiologic methods to evaluate effects of HIV treatment strategies in adults and infants. A K01 award will provide the necessary additional training and experience needed to become an expert in the design, implementation, and evaluation of interventions to improve pregnancy outcomes in HIV-positive women and underserved populations. Career Development and Training Plan. My education program includes structured course work, professional conferences, directed readings, and a research project with specific aims timed to coincide with these activities. My mentorship team includes international experts who specialize in areas related to my training goals: Dr. Scott Braithwaite (decision science), Dr. Roger Shapiro (HIV and maternal and child health in Botswana), Dr. Donna Shelley (intervention development and implementation), and Dr. Carolyn Berry (qualitative methods). Environment. NYU School of Medicine provides an exceptional environment for me to conduct the proposed study, obtain additional training and mentorship, and successfully transition to an independent investigator. Research Strategy. Using the data and infrastructure from an ongoing birth outcomes surveillance study in Botswana consisting of data from over 130,000 births, my study will: 1) estimate the effect of iron and folic acid supplementation during pregnancy on adverse pregnancy outcomes by HIV status, anemia, gestational age, and other key subgroups to identify populations that would benefit most from intervention; 2) assess barriers to supplementation during and prior to pregnancy; 3) optimize a hypothetical intervention to provide supplementation using computer simulation; and 4) develop and test the feasibility of an intervention to provide supplementation to pregnant women in Botswana.